A Greenville, North Carolina medical biller was sentenced to 108 months in federal prison after pleading guilty to Medicaid fraud and identity theft charges. Donnie Lee Phillips II will be eligible for early release after 7 years and 8 months. U.S. Senior District Court Judge James Fox also ordered him to serve an additional 3 years of supervised release and pay $5,722,364 in restitution.
Donnie Phillips background as a medical biller and life story make this story interesting. Most Medicaid fraud suspects are the doctors / pharmacists / clinic owners directly benefitting from the scam. Phillips, however, was a professional medical biller. He helped others commit the fraud while just receiving a small percentage of the proceeds.
Donnie Lee Phillips II Background
According to his lawyer, Phillips is 37 years old and a single father. Court records say that he was an honor society graduate Jacksonville High School in North Carolina. He later graduated East Carolina University with a degree in communications.
While in school, Phillips was active in the Honor Society, the Fellowship of Christian Athletes and the Future Business Leaders of America. While in college he also played football and later tried out for the Miami Dolphins.
Since his graduation, he volunteered at the Boys and Girls Club and until 2015, served a youth pastor at the Oak Grove Christian Church. Prior to this week’s sentencing, a retired general wrote a glowing character reference of Phillips. In other words, he doesn’t exactly meet the profile of someone behind an almost $6 million theft from taxpayers.
So what went wrong? Much of the record in this case has been sealed by the court meaning it can’t revealed. We know the court ordered him to receive intensive drug treatment while in prison. Did a drug addiction cause him to lead a double life?
What we can do know and can share is what is in the indictment.
Justice Department Charges Phillips with Medicaid Fraud, Identity Theft
Prosecutors say that Phillips was a professional medical biller. He operated a company that helped healthcare providers code medical information and get paid from Medicaid and Medicare. Instead of submitting accurate bills for services performed, however, he conspired with several providers to grossly inflate those bills and even submit phony bills for services never even performed.
The scheme was so elaborate that Phillips would share the phony bills with the providers so that they could in turn create phony medical records to match the information on the bills.
Phillips wasn’t the kingpin or organizer of the scheme but it certainly could not have taken place without him. As the medical billing professional, the others relied on Phillips to create the phony bills. Phillips received a piece of the action for his role in the scheme. His cut was approximately $300,000.
The identity theft charges relate to the patient names used by Phillips when submitting bills to Medicaid. The identities of approximately 2000 kids were used without their permission.
The alleged kingpin, Terry Speller, was sentenced earlier this year to 20 years in prison. Unlike Phillips who cooperated, Speller intimidated a federal witness in the case.
HHS Warns Others Considering Medicaid Fraud Crimes
After the sentencing, a Health and Human Services spokesperson said, “When fraudsters like Donnie Lee Phillips bill Medicare and Medicaid for services never provided just to enrich themselves, the integrity of these taxpayer-funded health care programs is at risk. The sentence handed down in this case is a warning that health care fraud will not be tolerated.”
Lessons Learned
All the major billing and coding organizations require their members to adhere to a strict code of ethics. Although Medicaid fraud is rampant, we rarely see professional coders as active participants in these illegal schemes. The five year sentence handed down by Judge Fox is a clear warning to professional coders. If they cross the line and participate in these schemes, the consequences will be severe even if they only get a small percentage of the criminal proceeds.
Whistleblower Awards for Medicaid Fraud Whistleblowers
As indicated earlier, much of this case remains under seal. We don’t know how Phillips and Speller were caught. We do know that Phillips was taped discussing the fraud with a provider. Was the provider a whistleblower? We don’t know yet.
Under the False Claims Act, whistleblowers with inside information about Medicaid fraud are eligible for cash awards. To qualify, you must be the original source of the information you are reporting. Information already in the public domain can hurt your case. Ditto if someone else files first. That means speed is important.
Obtaining an award means filing a lawsuit in federal court. While being investigated, the case is sealed meaning it is secret.
Worried about paying a lawyer to file, investigate and prosecute your case? Don’t be. We handle these cases on a contingent fee basis meaning no fees or costs unless you win and collect.
MahanyLaw – America’s Medicaid Fraud Whistleblower Lawyers
Our whistleblower clients have received over $100 million in recent years. You could be next. Our goals are simple. We help clients stop fraud and collect the largest awards possible. We also protect our clients in the event of illegal workplace retaliation.
Want more information? Visit our medicare fraud information page. Better yet, call us! The author of this post, attorney Brian Mahany, can be reached at *protected email* or by telephone at (414) 704-6731.
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